Evaluation of Frailty Assessment Tools and their Measurement Properties in Chronic Kidney Disease

• Author / Creator

  Puri, Alisha

• Background:
  Frailty is three to seven times more common in people with chronic kidney disease (CKD) than in those with normal kidney function. Although frailty and its impact in CKD is well-recognized, the measurement properties of the tools used to assess this syndrome are not known. The aim of this systematic review was to evaluate frailty assessment tools and their measurement properties in CKD.

  Methods:
  The study was conducted using the Consensus-based Standards for the selection of health Measurement Instruments (COSMIN) guidelines and Preferred Reporting Items for Systematic reviews and Meta-Analyses for Protocols (PRISMA-P 2015). We searched ten electronic databases and screened studies as per the inclusion criteria: peer-reviewed original research, adults with CKD (non-dialysis, dialysis or kidney transplant (KT)), examines at least one established multidimensional tool used for the assessment of frailty, and presents information to evaluate the measurements properties of the tool. Methodological quality assessment and data synthesis were performed as per COSMIN guidelines. This review was registered with PROSPERO (CRD42021234558).

  Results:
  We retrieved 648 unique citations with 52 eligible studies of which a majority (n = 37, 71.1%) were prospective cohort studies. A large proportion (n = 12, 23%) of the data was retrieved from prevalent dialysis patients. There was limited data (n = 4, 7.7%) available for KT recipients due to population overlap. Across all studies, the Fried Frailty Tool (original: n = 27, 51.9%; modified: n = 8, 15.4% of studies) was used most frequently. Only three measurement properties were evaluated for the frailty measurement tools: construct validity (discriminative (n = 42, 80.8%); convergent (n = 9, 17.3%), criterion validity (n = 2, 3.8%), and responsiveness (n =2, 3.8%). Studies using the Fried Frailty Tool most commonly evaluated the tool’s discriminative validity. Only in the CKD non-dialysis population, the Fried Frailty Tool demonstrated good discriminative ability (pooled adjusted hazard ratio (aHR): 2.00 (95% CI: 1.51, 2.64, p < 0.001) in estimating the risk of death. Upon assessing the methodological quality of all 52 studies, 51 (98%) had inadequate methodological quality. Only one study comparing the Fried Frailty Tool to the Geriatric Assessment (GA) (criterion validity) was assessed as doubtful methodological quality. Due to the inadequate methodological quality, when rating the studies against the “Updated Criteria for Good Measurement Properties”, all studies presented “indeterminate” overall quality. The quality of evidence per single study or pooled result was graded and resulted in “very low” quality of evidence. Finally, due to the lack of data, we cannot comment on the interpretability and feasibility of the frailty assessment tools used in each study.

  Conclusions:
  We aimed to identify the frailty tools validated in CKD and provide a recommendation for a tool(s) for use in clinical research and practice. Although a number of frailty tools exist, only a number have been validated in CKD populations, such as the Fried Frailty Tool, Clinical Frailty Scale (CFS), Frailty Index (FI), Comprehensive Geriatric Assessment (CGA)/GA, FRAIL Scale, and Groningen Frailty Indicator (GFI). The Fried Frailty Tool was used most frequently across all CKD subpopulations and provided sufficient data for construct (discriminative and convergent) validity and criterion validity. However, due to low study quality, we cannot recommend the Fried Frailty Tool with confidence. Additionally, this review also did not identify any studies evaluating the frailty tools' reliability, measurement error, structural validity, internal consistency, and content validity. Hence, we cannot provide a recommendation for a tool(s) as per the COSMIN guidelines for use in clinical research and practice.

• Subjects / Keywords

  • Measurement Properties
  • Chronic Kidney Disease
  • Frailty
  • Validity
  • Reliability
  • Frailty assessment tools

• Graduation date

  Spring 2022

• Type of Item

  Thesis

• Degree

  Master of Science

• DOI

  https://doi.org/10.7939/r3-vyf6-2n79

• License

  This thesis is made available by the University of Alberta Libraries with permission of the copyright owner solely for non-commercial purposes. This thesis, or any portion thereof, may not otherwise be copied or reproduced without the written consent of the copyright owner, except to the extent permitted by Canadian copyright law.